Relata-se o caso de uma jovem, heterozigota para doença de Fabry, que desenvolveu infartos talâmicos bilaterais por oclusão de vasos do sistema nervoso central. Três outros membros de sua família foram também avaliados. A doença de Fabry inclui-se entre as causas raras de acidente vascular cerebral em adultos jovens.

An unusual case of a young woman, heterozygote for Fabry gene is reported, who presented bilateral thalamic infarcts due to occlusions of central nervous system vessels. Three other members of her family were studied. Fabry's disease (angiokeratoma corporis diffusum) is included among the rare causes of ischemic stroke in young adults.

Foram estudados 64 casos de doença de Parkinson idiopática mediante aplicação de questionário de 30 itens de avaliação neuropsicológica. Os casos com desempenho abaixo do normal e que preenchiam os critérios de demência do Manual de Diagnóstico e Estatística de Distúrbios Mentais, terceira edição (DSM III) foram considerados demenciados. O resultado dessa avaliação mostrou que a taxa de prevalência de demência no grupo de parkinsonianos estudado foi de 18,7%. Pacientes com desempenho abaixo do normal apresentavam oligocinesia em maior grau que o grupo dos normais. Das funções neuropsicológicas, as mais afetadas foram: memória imediata, abstração, gnosia visual, cálculo, função motora dinâmica das mãos, praxia construtiva e memória recente. Discutem-se os dados encontrados e comparam-se com os da literatura.

Sixty-four cases of idiopathic Parkinson's disease were studied focusing the neuropsychological performance. To all subjects a brief mental status questionnaire was administered (30 items). Cases with a performance below normal and meeting the dementia criteria of the Diagnosis and Statistical Manual of Mental Disorders, third edition (DSM III), were considered demented. This evaluation showed that 12 of the 64 patients had dementia, a prevalence rate of 18.7%. Patients that had neuropsychological performance below normal showed more severe bradykinesia than normals. Short term memory, abstract thinking, visual gnosia, calculations, dynamic motor function of hands, constructional ability and recent memory were the most affected psychological functions. The significance of the mentioned findings is discussed and the literature reviewed.

São relatados os casos de dois irmãos com tomografia computadorizada de crânio evidenciando lesões hipoatenuantes dos gânglios da base. No caso 1 a anormalidade é de maior dimensão, bilateral e associa-se a quadro neurológico em que as alterações mais importantes são: presença de posturas distônicas, principalmente nos membros inferiores e reflexos patelares exaltados, com clono de rótula bilateral. No caso 2 a alteração tomográfica estava presente com localização semelhante, porém menor e somente à esquerda e o exame neurológico é normal apesar do relato de quedas freqüentes. Os autores discutem o diagnóstico diferencial do ponto de vista clínico e tomográfico.

Two cases (siblings) with computed tomography showing slow attenuation of basal ganglia are reported. In case 1 the abnormality is larger, bilateral and the most important neurological features are: dystonic postures mainly in lower extremities and very active patellar reflexes with sustained knee clonus on both sides. In case 2 the tomographic examination disclosed a similar, but more discrete lesion only on the left side; the neurological examination is normal despite a history of frequent falls. The authors discuss the differential diagnosis from a clinical and tomographic approach.

O presente estudo teve como objetivo a análise crítica dos critérios diagnósticos na degeneração hepatolenticular (DHL). Foram estudados 95 casos de DHL, com enfoque na caracterização clínica e laboratorial da doença. No aspecto clínico foram analisadas a variabilidade quanto ao modo de instalação da moléstia e a freqüência do anel de Kayser-Fleischer (K-F). Em relação aos exames complementares foram analisados os níveis de ceruloplasmina, cobre sérico, cobre urinário e aminoacidúria, o estudo radiológico e cintilográfico do esqueleto, a tomografia computadorizada de crânio e a biópsia hepática. Em 54,4% dos casos o quadro clínico inicial foi neurológico, em 31,1% hepático, em 14,4% psiquiátrico, em 7,8% ostearticular, em 2,2% oftalmológico (anel de K-F), em 1,1% hematológico (anemia hemolítica) e em 1,1% cardíaco. O anel de K-F estava presente em 84 dos 92 casos em que foi pesquisado (91,3%). Quanto aos resultados laboratoriais, hipoceruloplasminemia foi assinalada em 98,8% dos casos avaliados, hiperaminoacidúria em 94,7%, hipocupremia em 87,0%, hipercuprúria em 78,2%, osteoporose em 79,4%, alterações cintilográficas das articulações em 65,2%, e a tomografia de crânio, realizada em 11 casos, mostrava, em 2, áreas hipoatenuantes nos gânglios da base. Discute-se a importância dos exames complementares acima citados e do anel de K-F como elementos para a caracterização da DHL.

Ninety-five cases of hepatolenticular degeneration have been studied, focusing particularly the clinical and laboratory characterization of the disease. On the clinical viewpoint the variability of the starting symptoms and the frequency of the Kayser-Fleischer rings were analyzed. As regards the laboratory findings the ceruloplasmin, blood and urinary copper, and aminoaciduria levels have been evaluated, as well as the radiological and scintillographic study of joints and bones, cranial computerized tomography and liver biopsy. In 54.4% of the cases the opening clinical picture was neurological, in 31.1% hepatic, in 14.4% psychiatric, in 7.8% osteoarticular, in 2.2% ophtalmologic (Kayser-Fleischer rings), in 1.1% hematologic (hemolytic anemia), and in 1.1% cardiac. Kayser-Fleischer rings were present in 84 of the 92 cases in which they have been searched for (91.3%). Concerning the laboratory findings, hypoceruloplasminemia was found in 98.8% of the cases in which it was investigated, hyperaminoaciduria in 94.7%, hypocupremia in 87.0%, increased cupruresis in 78.2%, osteoporosis in 79.4%, scintillographic changes of the joints in 67.6%; the CT-scan, performed in 11 cases, showed low attenuation areas in the basal ganglia of 2 patients. The significance of the mentioned laboratory findings and the presence of the Kayser-Fleischer rings for the diagnosis of Wilson's disease is discussed.

É relatado o caso de um paciente de 14 anos, do sexo masculino, com esclerose cerebral difusa precedida em 7 anos de sinais de insuficiência do córtex supra-renal, com antecedentes familiares. Clinicamente a doença é caracterizada por deterioração mental, distúrbios da marcha e da visão, associados com insuficiência do córtex supra-renal. Confirmando os dados da literatura, em nosso caso o estudo anátomo-patológico revelou desmielinização e gliose difusa na substância branca cerebral, poupando as fibras subcorticais. Células inflamatórias são comuns e têm distribuição perivascular. Na zona fasciculada e reticular da supra-renal, células "balonadas" são evidentes, muitas delas apresentando citoplasma vacuolizado e com estriações. Inclusões lipídicas similares têm sido encontradas nas células de Schwann dos nervos periféricos e dos testículos. Os achados são comparados com vinte casos da literatura.

The case of a 14-year-old boy with "diffuse cerebral sclerosis", preceded by signs of primary adrenal cortical insufficiency for 7 years with familiar antecedents is reported. This disorder, named adrenoleukodystrophy, has a sex-lin(ed recessive inheritance. The clinical picture is characterized by mental deterioration, gait disturbances, visual impairment, associated with primary adrenal cortical insufficiency. Confirming the data from literature, in our case the pathological study showed myelin degeneration and diffuse gliosis in the cerebral white matter, with no involvement of subcortical fibers. Inflammatory cells are common, and have a perivascular distribution. In the fasciculata and reticular zones of the adrenal gland, "baloon-shaped" cells are evident, most of them presenting a vacuolized and striated cytoplasm. Similar lipidic inclusions have been found in the Schwann cells of the peripheral nerves and testis. The findings are compared with twenty cases from the literature.

Os autores registram caso de paciente na qual, após intoxicação aguda por arsênico inorgânico, instalou-se quadro de polineuropatia periférica. Foram verificadas altas concentrações de arsênico no nervo periférico estudado (1,48 mg/100 g peso seco, e 0,49 mg/100 g peso fresco) e na urina. Antes do tratamento com penicilamina a quantidade de arsênico excretada na urina era de 80,0 micro/100 ml; após 7 dias de tratamento a excreção passou a ser de 150,2 micrograma/100 ml. Estes resultados bioquímicos foram acompanhados de progressiva melhora clínica.

Report of a case of acute intoxication by inorganic arsenic with a picture of peripheral polyneuropathy. High concentrations of arsenic were found in the peripheral nerve studied (1.48 mg/100 g fresh tissue; 0,40 mg/100 g dry tissue) blood and urine. Before the treatment with penicillamine the urinary concentration of arsenic was 80,0 micrograms/100 ml; 7 days after the onset of treatment the excretion increased to 150.2 micrograms/100 ml. Improvement of the clinical conditions was parallel to these biochemical results.

Registrando 5 casos de dissinergia cerebelar mioclônica e 3 casos de epilepsia mioclônica os autores fazem revisão de alguns problemas referentes a essas afecções, especialmente no que se refere às mioclonias que são analisadas à luz dos conhecimentos anátomo-patológicos e eletrencefalográficos. Sob o ponto de vista anátomo-patológico é chamada a atenção para o caráter dinâmico das lesões, de forma que, num dado momento, surpreende-se um quadro histológico que pode estar em franca evolução; isso explica a variedade dos achados anátomo-patológicos registrados na literatura, mas sempre com uma base anatômica comum, localizando-se as lesões produtoras de mioclonias no circuito olivodentorrúbrico (triângulo de Guil-lain e Mollaret). Os autores tentam explicar as mioclonias em geral, por lesão de um ou de vários pontos compreendidos nesse circuito, ressaltando a importância, provàvelmente fundamental, da substância reticular do tronco cerebral. Na opinião dos autores, os achados eletrencefalográficos concordam com os dados anátomo-patológicos, no que diz respeito à topografia das lesões. Pelo estudo eletrencefalográfico, durante injeção de substância curari-zante (cloreto de succinilcolina), com conseqüente supressão dos fenômenos musculares, os autores verificaram que essa substância altera a morfologia das descargas disrítmicas e diminui seu número. A diminuição da freqüência das descargas é interpretada pelos autores como podendo resultar de um número maior de estímulos dirigidos aos motoneurônios que ao córtex, partindo de estruturas subcorticais responsáveis pelas mioclonias; durante a ação do cloreto de succinilcolina seriam registrados apenas os estímulos corticais, mais raros. Outra possibilidade aventada pelos autores seria a ação anticonvulsionante do cloreto de succinilcolina, o que ainda não foi demonstrado. Embora ambas as afecções, em certos casos, apresentem um quadro clínico muito semelhante, a histopatologia permite separá-las em entidades clínicas distintas.

Five cases of myoclonic cerebellar dyssynergia and 3 cases of myoclonic epilepsy are reported. The authors make a revision of the problem, specially about myoclonic manifestations. Myoclonus is analyzed pathologically and electroencephalographically. From the pathological point of view the dynamic feature of the lesions is emphasized, so that, at a given time, it is possible to have a histological picture that is in progression. This explain the variety of pathological descriptions in the literature, even though all of them have a common anatomical basis, the olivodentorubral triangle being the site of the lesions producing myoclonus. The authors try to explain myoclonus as caused by lesions of one or several points in this triangle, emphasizing the importance of the reticular formation of the brain stem. It is the opinion of the authors that the electroencephalographic patterns agree with the pathological findings in what concerns the site of the lesions. The authors verified that, by making an electroencephalographic record with the aid of a curare-like drug (succynilcholine chloride), which suppresses the muscular component, the morphology of the waves is changed and the frequency of the paroxysms is diminished. The decrease in the frequency of discharges is interpreted as being the result of a greater number of stimuli directed to the motoneurons than to the cerebral cortex, starting in subcortical structures which are responsible for the myoclonus; during the action of succynilcholine chloride only the cortical discharges, which are rarer, would be registered. Or else, this curare-like drug would have an anticonvulsivant action which has not yet been demonstrated. Although both diseases, in some cases, have a very similar clinical picture, it is possible, on histopathological grounds, to regard them as two distinct clinical conditions.

Os autores estudam os tumores derivados de inclusões de tecidos embrionários ectodérmicos, seja de epitélio malpighiano (cistos epidermóides), seja os que incluem também elementos do derma (cistos dermóides). São feitas críticas às denominações de colesteatoma e tumor perláceo, com que os primeiros também são conhecidos. É frisada a raridade dêstes tumores entre as neoplasias do sistema nervoso, particularmente dos epidermóides espinais e dos dermóides diplóicos. Constituem caráter clínico comum a lenta evolução e a incidência em jovens. A sintomatologia neurológica é extremamente variada, pois êsses cistos podem situar-se em tôdas as porções do neuraxe. Certas formas comportam quadro clínico que poderá aventar a etiologia. São relatados 12 casos de cistos epidermóides (sendo 3 espinais) e 2 de dermóides (incluindo um diplóico). É chamada a atenção para a possibilidade de ocorrerem alterações do liqüido cefalorraqueano capazes de induzir a diagnósticos errôneos, especialmente de neurossífilis e de neurocisticercose.

The authors study the tumors derived from inclusions of foetal ectodermal tissues, either of Malpighian epithelium (epidermoid cysts) or those also including dermal elements (dermoid cysts). The authors criticize the words cholesteatoma and pearly tumor, often applied to the former growths. The rareness of these cysts among nervous system tumors (particularly spinal epidermoids and diploic dermoids) is stressed. Sluggish development and incidence in youth are clinical features of both. The neurological symptomatology is extremely varied, since these tumors can be found in ?very site of the neuraxis. Some forms show peculiar signs which can point to their etiologic diagnosis. The authors report 12 cases of epidermoid (including 3 of the spinal canal) and 2 cases of dermoid cysts (including one of the diploe). Attention is called to eventual changes of the cerebrospinal fluid that may lead to erroneous diagnosis such as neurosyphilis and cysticercosis of the nervous system. The general rules and results of the surgical management are briefly analysed. In their own cases the authors had three post-operative deaths and three deaths not related to craniotomy (two preoperative and one due to an intervening cause: perforation of gastric ulcer); in the other cases improvement was achieved by surgery.

O autor, revendo o conceito atual da etiopatogenia das mieloses funiculares, conclui que, na determinação do processo desmielinizante, além da carência de vitamina B12 e da acloridria gástrica, participam outros fatores, carenciais e/ou alérgicos. Baseado no estudo de 110 casos com lesões gástricas constitucionais (100 casos) ou adquiridas (10 casos), o autor discute o problema do diagnóstico. São consideradas as síndromes periférica, funicular dorsal, "piramidal" e encefálica. É ressaltada a importância do exame da sensibilidade vibratória, particularmente por método quantitativo, que revelou, em elevada percentagem dos casos, distúrbios da palestesia também nas mãos. Entre os exames complementares, é salientado o valor do hemograma, do mielograma, da dosagem da acidez gástrica, da determinação da absorção da vitamina B12 radioativa; são também consideradas as alterações electrencefalográficas e do liqüido cefalorraqueano. Os resultados terapêuticos em 44 casos são avaliados através do estudo semiquantitativo da sintomatologia neurológica. Embora a vitamina B12 tenha proporcionado maiores índices de melhora, os demais medicamentos (extrato hepático, ácido fólico e adrenocorticotropina) também influenciaram favoravelmente o quadro neurológico. Em vista da pequena representação numérica da casuística nos grupos correspondentes aos quatro esquemas terapêuticos, o autor não emite conclusão definitiva. Salienta, porém, que êsses resultados demonstram a necessidade de prosseguir nos estudos sôbre a etiopatogenia das mieloses funiculares, no sentido de esclarecer as numerosas incógnitas que ainda perduram.

After a review on the present concept of the etiopathogenesis of funicular myelosis (subacute combined degeneration of the spinal cord) the author states the conclusion that in the causation of the demyelinating process, besides the lack of vitamin B]2 and gastric achlorhydria, other deficiency or allergic factors take part. Based on the study of 110 cases with constitutional (100 cases) or acquired (10 cases) gastric lesions, the author discusses the problem of the diagnosis. Peripheral, dorsal funicular, "pyramidal", and encephalic syndromes are considered. The importance of the examination of the vibration sense, particularly by quantitative methods, is emphasized; in a great percentage of cases, disturbances of this sensation were also disclosed in the upper limbs. Among the laboratory findings, the value of blood count, bone-marrow smear, gastric acidity analysis, and the study of absorption of radioactive vitamin B12 is stressed. Changes in the electroencephalogram and cerebrospinal fluid are also considered. Therapeutic results in 44 cases are estimated by the semi-quantitative study of the neurological signs. Although vitamin B12 displayed higher degree of improvement, the other drugs (liver extract, folic acid and adreno-corticotropin) have also influenced favorably the neurological manifestations. Owing to the low numerical representation of cases in the groups corresponding to the four schemes of treatment, the author does not state a definite conclusion. But he emphasizes that these results demonstrate the need of further studies on the etiopathogenesis of funicular myelosis, in an attempt to settle the several questions still unsolved.

The author studies the significance of the accurate test of vibration sense for the diagnosis of some diseases of the nervous system. This work is divided into three main parts. First part - After reviewing the medical literature on the nature, pathways and physiopathology of the vibration sense, the author states the following conclusions : 1. Pallesthesia is an inespecific type of sensation. 2. The receptors for vibratory stimuli include both the superficial structures designed to record the cutaneous deformation, and the end-organs located in the muscles, ligaments, joints and periosteum. 3. On the light of more recent experimental work, carried on by neuro-physiologists and clinical neurologists, it becomes evident that the muscle spindles are the end-organs mostly concerned in the reception of vibratory stimuli. 4. These facts lead to the conclusion that vibration sense impulses run in the spinal cord by tactile and proprioceptive pathways. There are reasons to believe that lesions of the dorsal funiculi are more apt to interfere with the conduction of vibratory stimuli. 5. The dissociation between pallesthesia (lost or impaired) and joint sense (impaired or normal), frequently met with in several nervous diseases, must be ascribed to the fact that injury of nerve fibers lengthens the refractory period; the vibratory stimuli, which normally are transmitted almost in the limit of nerve fiber ability, are thus summed up and does not evoke the vibratory sensation any more. 6. The prevalence of kinesthesic over pallesthesic disturbances, which is said to occur in lesions of parietal lobes, can be explained by the discriminative character of the former type of sensation, as well as by a wider bilateral cortical representation of the vibration sense pathways. Second part - The analysis of variance of the vibratory perception thresholds measured with the "Bio-thesiometer" in 55 normal subjects lead the author to the following conclusions: 1. The vibration perception thresholds show wide variations according to the bodily area which is tested. 2. The variations of the vibration perception thresholds among subjects, although great, are lesser than the changes among bodily areas. 3. Among the bodily areas studied, the fingers and toes were the most sensitive to vibratory stimuli. 4. The vibration perception thresholds in the head are very high and are prone to great individual variations. 5. The least individual variations were shown by the bodily areas more sensitive to vibratory stimuli. 6. All these facts point to the selection of the fingers and toes as the bodily areas more suitable for the quantitative test of pallesthesia, with diagnostic purposes or to estimate the course of nervous diseases. 7. The variations of the vibration perception thresholds during regular time intervals (3 days) have not been significant in relation to the variations among bodily areas and subjects. 8. The average vibration perception thresholds of the left side of the body were lesser than those of the right side, although only in the great toes the difference was statistically significant. 9. It has been statistically proved that the method used in this work is a trustful procedure for the quantitative study of vibration sense. Third part - The study of 126 cases of nervous diseases due to lesions of various topographies, using the same quantitative method, allowed the following conclusions: 1. Vibration sense can be the only form of sensation impaired in several kinds of nervous diseases. 2. The quantitative test of pallesthesia has great semiotic significance since the increase of the vibration perception thresholds can be the only sign of damage of the sensory pathways. 3. Dissociation between pallesthesia and kinesthesia can be observed in several nervous diseases and as well in peripheral as in central lesions. 4. In cases of diabetic neuropathy the impairment of vibration sense is frequent and sometimes very conspicuous; it bears a close relation to the severeness of the whole neurologic picture. 5. In cases of herniated nucleus pulposus the test of vibration sense can cooperate in the diagnosis of the side of the protrusion. However, it must be emphasized that the changes in pallesthesia have not, in such cases, the semiotic significance which some authors have assigned to them. 6. In the subacute combined degenerations of the spinal cord, with constitutional or acquired achlorhydria, the test of vibration sense is imperative, owing to the early and marked impairment of this form of sensation. The quantitative method can disclose, in several cases, the existence of pallesthesic changes not shown by routine procedures, particularly those involving the upper limbs. 7. In poliradiculoneuritis the vibration sense is deeply impaired, even in the upper limbs, where other forms of sensation can be normal by routine examination. 8. In trigeminal nerve lesions the quantitative test of vibration sense is of little semiotic significance, owing to the great variability of the thresholds in the head and to the frequent confusion between vibration and auditory senses. In the four cases tested the increase of the thresholds was slight, even in two cases with associated facial palsy. 9. In cases of parietal lobe injuries, including two cases of hemisphe-rectomy, the impairment of vibration sense is remarkable and coincident or not with changes in the joint sense. 10. In other diseases of the nervous system, the quantitative test of vibration sense has proved worthful for the diagnosis, either as a positive or sometimes as a negative finding.

Os autores apresentam os resultados imediatos do emprêgo do ACTH em 4 casos de neuropatía desmiel in izante aquílica. Justificam o uso dêsse hormônio em vista da possível patogenia alérgica dos processos desmielinizantes primarios. O ACTH foi administrado por via intravenosa, sem qualquer outra medicação associada que pudesse interferir nos resultados. Êstes foram avaliados do ponto de vista quantitativo e evidenciaram discreta ação benéfica do hormônio, avaliada em 28,8%, em média. A decisão quanto ao efeito do ACTH nas mieloses funiculares só será possível após maior experiência, baseada em mais volumosa casuística e no segui- mento dos pacientes, bem como no estudo comparativo dêsses resultados com os obtidos com o emprêgo dos demais medicamentos de uso corrente.

Report on the immediate results of the use of ACTH in 4 cases of achylic demyelinating neuropathy. This treatment is justified by the possible allergic pathogenesis of the primary demyelinating processes. Dayly dosis of 12.5 mgm of corticotropin were given by continuous drip method, without any other associated drug which could interfere in the results. These were estimated on a semi-quantitative basis and evidenced slight beneficial effects of the hormone, which averaged 28.8 per cent. The accurate evaluation of the effects of corticotropin in subacute combined degeneration of the cord demands larger experience, based on greater number of cases and follow up of the patients, as well as the comparative study of such effects and the results obtained with classic treatment (liver extract, folic acid and vitamin B12).

Estudo da evolução dos quadros liquóricos em 50 casos de neurossífilis submetidos aos seguintes processos terapêuticos: 1) malária e arsênico; 2) penicilina isolada; 3) penicilina, piretoterapia e arsênico; 4) penicilina e piretoterapia; 5) arsenoterapia isolada. Entre os dados fornecidos pelo exame do liqüido cefalorraqueano, só constituíram objeto de estudo a cito-metria, a taxa de proteínas, a reação do benjoim coloidal e as reações de desvio de complemento para sífilis. Em 34% dos casos foi obtido retorno à normalidade; em 42%, resultados satisfatórios; em 22%, resultados indefinidos; em 2%, falência do tratamento e recidiva. A aplicação da estatística t aos resultados liquóricos revelou: a) significância das diferenças entre os valores iniciais e finais da citometria, da proteinorraquia e da reação do benjoim coloidal, quer nos 45 casos, quer nos casos com 6 meses de seguimento, quer ainda nos três principais grupos terapêuticos; b) a comparação das médias finais da citometria nestes três grupos não revelou diferenças significantes: c) quanto à taxa de proteínas e à reação do benjoim, o mesmo processo comparativo revelou não haver significância entre os resultados dos grupos 1 e 3, enquanto que o grupo 2 diferiu significantemente dos demais; d) não houve diferença significante nas percentagens de negativaçao das reações de desvio de complemento, por qualquer dos três métodos de tratamento; e) foi significante a diferença entre as percentagens de negativaçao da reação de Wassermann e da de Steinfeld. Os resultados do estudo estatístico levam, pois, à conclusão de que os efeitos determinados pela penicilinoterapia isolada (grupo 2), embora eqüivalentes, no tocante à citometria, aos obtidos pelos demais méte dos de tratamento, foram superiores no referente à taxa de proteínas e à reação do benjoim coloidal. Este fato surpreendeu-nos, pois esperávamos que, se predomínio houvesse entre os três processos, êle deveria caber ao grupo 3, que consiste na soma dos meios terapêuticos utilizados nos grupos 1 e 2. Dados os riscos inerentes à malarioterapia, conclui-se que o tratamento atual de escolha, em casos de neurolues, é representado pelo emprego exclusivo da penicilina, em doses elevadas. A substituição da penicilina cristalina pela procainada, parece possível à vista da experiência dos autores americanos.

Therapeutic results in 50 cases of neurosyphilis Cerebrospinal fluid changes were studied in 50 cases of neurosyphilis, which were treated as follows: 1) malaria and arsenotherapy, 10 cases; 2) penicillin alone, 13 cases; 3) penicillin, fever and arsenotherapy, 21 cases; 4) penicillin and fever therapy, 3 cases; 5) arsenotherapy, 3 cases. Results of treatment were evaluated by the study of cell count, total protein contents, colloidal benzoin test and complement fixation tests for syphilis with heart antigen (Wassermann test) and human brain antigen (Steinfeld test). Return to normality was achieved in 34 per cent of the cases; satisfactory results, in 42 per cent; indefinite response, in 22 per cent; failure of treatment, in 2 per cent. The use of t statistics for the evaluation of results evidenced: a) significance of differences between inicial and final means of the cell count, total protein contents and colloidal benzoin test in the whole group of patients, in the 23 cases with 6 months of follow up and in the three main therapeutic groups; b) non significant differences between the final means of the cell count in these therapeutic groups; c) in what regards the total protein contents and the colloidal benzoin test, the statistical study of final means revealed no significant differences between groups 1 and 3, whether group 2 differed significantly from the others; d) there was not significant differences in the percentages of negativation of complement fixation tests in the three therapeutic groups; e) the differences in the percentages of negativation of complement fixation test with cardiac antigen (Wassermann test) and human cerebral antigen (Steinfeld test) were significant. These results lead to the conclusion that penicillin therapy alone, though equivalent to the other methods of treatment in what refers to the cell count, is more effective concerning the total protein contents and the colloidal benzoin test. This is surprising because method 3, which is the sum of methods 1 and 2, was supposed to be more effective. Considering the dangers involved in malariatherapy, penicillin alone is thus the treatment of choice for neurosyphilis, in total doses of ten to fifteen million units. Replacement of crystalline by procaine penicillin (which is on study in the Department of Neurology) seems to be possible according to the experience of American writers.

Foram determinadas, em 11 casos de anemia megaloblástica, aquílica, com degeneração dorsolateral da medula, as taxas de colesterol no sôro e de fosfolípides e fósforo inorgânico no sôro e lìquor, antes e após tratamento pela vitamina B12. As dosagens foram correlacionadas ao quadro hematológico. As cifras médias obtidas revelam a existência de normocolesterolemia, hiperfosfatidemia, hiperfosforraquia e hipofosfatemia na neuranemia; o estudo particularizado de cada caso mostra que, nas anemias mais graves, esses constituintes atingem níveis muito baixos. Após o tratamento, verifica-se aumento de tôdas as taxas médias; individualmente, observa-se que as variações são, em geral, concordantes, as melhoras hematológicas traduzindo-se por elevação do teor de colesterol e fosfolípides no sangue e, menos regularmente, por aumento do fósforo inorgânico no sangue e líquor.

In 11 cases of megaloblastic, achylic anemia with subacute combined degeneration of the spinal cord, the author has estimated the blood contents of cholesterol and the blood and cerebrospinal fluid contents of phospholipids (in lecithin) and inorganic phosphorus, before and after treatment with vitamin B12. The estimations have been correlated to the hematologic condition. The mean amounts estimated show normal blood cholesterol, increased blood phosphatides and cerebrospinal fluid inorganic phosphorus and decreased blood inorganic phosphorus in neuroanemia; the study of each case shows that the cases of more severe anemia exhibited the lowest levels. After treatment, all the mean amounts increase. Individually, it is evidenced that the variations are generally concordant; the hematologic improvement is followed by a rise of the blood contents of cholesterol and phospholipids and, less consistently, by increase of the blood and cerebrospinal fluid inorganic phosphorus.